Diabetic retinopathy and CKD increased CV risk in diabetes patients: Study

A new study published in the journal of Diabetes Research and Clinical Practice showed that proliferative diabetic retinopathy (PDR) increased cardiovascular risk in more than 2 million people with type 2 diabetes (T2D) in a manner comparable to that of chronic kidney disease (CKD), with risk tripling when both conditions coexisted.

Because type 2 diabetes is strongly linked to an elevated risk of cardiovascular disease (CVD) and death, it is a significant global public health problem. Controlling cardiovascular disease risk factors is essential since it continues to be the primary cause of mortality for people with type 2 diabetes.

Studies with large populations have repeatedly demonstrated that CKD, a significant microvascular consequence of type 2 diabetes, raises the risk of CVD and death. Although its exact role is still unknown, diabetic retinopathy (DR) has also been found to be a risk factor for CVD in people with type 2 diabetes. The relationship between DR and CVD has been the subject of several meta-analyses.

Microvascular and macrovascular problems in diabetic individuals are influenced by age and sex. Notably, a greater risk of microvascular and macrovascular problems is linked to a younger age at diabetes diagnosis. Using a sizable cohort from the Korean National Health Insurance Service (NHIS), this study sought to assess the separate and combined effects of DR and CKD on the risk of CVD and mortality among people with type 2 diabetes. The data from the UK Biobank cohort was then used for external validation.

This research examined T2D patients without a history of CVD from the UK Biobank (n = 21,350) and the Korean NHIS cohort (n = 2,064,406). A composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular mortality was the main result. Adjusted hazard ratios (aHRs) for the primary outcome were higher in the Korean cohort for those with PDR (aHR 1.37), CKD (aHR 1.36), and both conditions combined (aHR 2.21), than in those without either condition.

Comparable outcomes were noted in the UK Biobank. With aHRs of 3.28 for those under 40, 1.77 for those between 40 and 64, and 1.29 for those over 65, PDR had the greatest impact on CVD in younger people. Overall, pDR and CKD, both independently and in combination, increase cardiovascular risk in individuals with T2D, particularly among younger age groups. These findings support incorporating PDR into cardiovascular risk assessment and management.

Reference:

Yeon Soo Park, Kyu Na Lee, Bo Kyung Koo, Soo Heon Kwak, Kyung Do Han, Min Kyong Moon., Diabetic retinopathy and chronic kidney disease synergistically increase the risk of incident cardiovascular disease in type 2 diabetes: Insights from two cohort studies., Diabetes Research and Clinical Practice., https://doi.org/10.1016/j.diabres.2025.112373